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Chapters 13 and 14

Med/Surg Chapter 13/14

Filtration movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane
BP is an example of which: filtration, diffusion of osmosis? Filtration, high hydrostatic pressure and BP can cause edema because water is always filtering out of the capillaries
Diffusion free movement of particles across a permeable membrane from an area of higher concentration to an area of lower concentration
Osmosis movement of water only though a selectively permeable membrane
Osmolarity number of particles in a liter of solution
Osmolality number of particles in a kilogram
Average intake of fluid for adult per day 1500 mL plus 800 mL from food
Minimum amount of urine needed to excrete waste 400-600 mL
Aldosterone reabsorbs water and sodium, increases osmolarity and blood volume. Prevents blood K levels from getting too high
ADH reabsorbs water, decreases blood osmolarity
NP secreted in response to increase BV and BP, releases water and sodium, decreasing osmolarity and blood volume
Changes in Dehydration Cardio- HR increases, peripheral pulses weak and difficult to find, BP decreases, neck veins flat. Resp- increased resp rate. Skin- reduced skin turgor. Neuro- change in mental status, slight fever. Renal- concentrated urine. Weight loss also indicator
Interventions in Dehydration Fall risk, fluid replacement, teach UAP to offer 2-4 ounces of fluid q hour. Administer IV if appropriate
Things to asses during rehydration pulse rate and quality and urine output
Changes in fluid overload Skin- pitting edema, pale, cool skin. Cardio- high HR, bounding pulse, elevated BP, distended veins, weight gain. Resp- high RR, shallow, dyspnea, moist crackles. Neuro- altered LOC, H/A, vision changes, skeletal muscle weakness. GI- high motility
Intervention in Fluid overload Safety, monitor for pulmonary edema, diuretics (furosemide), assess lab findings, fluid and Na restrictions, monitor I/O, check specific gravity, check weight. Tell pt to call Dr. for more than 3 lbs gain in a week, or 1-2 lbs per day
Sodium Norms- 135-145
Hypernatermia Assessment dry,sticky mucous membranes, flushed skin, firm skin turgor, intense thirst, edema, oli/anuria
Hypernatremia intervention weigh daily, assess degree of edema, measure I/O, assess skin for breakdown, Na restricted diet, hypotonic (0.225 or 0.45 NaCl) IV
Hyponatremia assessment N/V, abd cramps, weight loss, diarrhea, cold clammy skin, decreased skin turgor, shrunken tongue, apprehension, HA, convulsions, confusion, weakness, fatigue, postural hypotension, weak pulse
Hyponatremia intervention provide foods high in Na, administer NS by IV, assess BP frequently
Hypokalemia assessment Thready/rapid/weak pulse, faint heart sounds, decreased BP, skeletal muscle weakness, decreased/absent reflexes, shallow resps, malaise, apathy, lethargy, loss of orientation, anorexia, vomiting, weight loss, GI distention
Hypokalemia interventions stop K wasting diuretics, administer K supplements, monitor pH, monitor pulse/BP/EKG
Hyperkalemia assessment thready/slow pulse, shallow resps, N/V, diarrhea, intestinal colic, irritability, muscle weakness, numbness, flaccid paralysis, tingling, difficulty with phonation/ resps, spiked T wave, decreased BP
Hyperkalemia intervention administer kayexalate, administer/monitor IV infusion of glucose and insulin, control infection, provide adequate cals and carbs, Discontinue IV or oral sources of K.
Hypercalcemia assessment N/V, anorexia, constipation, HA, confusion, lethargy, stupor, decreased muscle tone, deep bone and/or flank pain, positive Trousseau and Chvostek signsNor
Hypercalcemia intervention encourage mobilization, limit vitamin D and Calcium intake, administer diuretics, protect from injury
Hypermagnesemia assessment lethargy, somnolence, confusion, n/v, muscle weakness, depressed reflexes, decreased pulse and resps
Hypermagnesemia intervention withhold magnesium containing foods, increase fluid intake
Hypomagnesemia assessment parasthesias, confusion, hallucinations, convulsions, ataxia, tremors, hyperactive DTR, muscle spasms, flushing of the face, diaphoresis
Hypomagnesemia interventions provide dietary sources of magnesium
Norm pH 7.35-7.45
Norm CO2 35-45
Norm Bicarb 21-28
Metabolic acidosis causes too much H- breakdown of fatty acids, anaerobic glucose breakdown, excessive intake of acids, starvation, seizures, heavy exercise, fever. Underelimination of H ions- renal failure. Under production of bicarb- renal failure, pancreatitis, liver failure.
Lab values of metabolic acidosis Ph low, Bicarb low, K high
Respiratory acidosis causes Underelimination of H ions- resp depression, inadequate chest expansion
Lab values of respirator acidosis pH low, CO2 high, K high
Acidosis S/S CNS- lower activity. Neuro- hyporeflexia, muscle weakness, paralysis. Cardio- delayed electrical conduction (tall T, widening QRS, prolonged PR), hypoTN, thready pulse. Resp- kussmaul resps (in metabolic). Skin- M(warm, flushed dry), R(pale/cyanotic, dry)
Metabolic Alkalosis causes increase base- increased antacids, blood transfusion, giving bicarb, TPN. Decrease of acid- prolonged vomiting, NG suctioning, hypercortisolism, hyperaldosteronism, thiazide diuretics
Lab values of metabolic alkalosis pH high, Bicarb high, K low
Respiratory Alkalosis causes excessive loss of CO2- hyperventilation (incl. mechanical ventilation), high altitudes, shock
lab values of Respiratory alkalosis pH high, CO2 low, K low
Alkalosis S/S CNS- increased activity, anx, irritable, tetany, seizures, + Chvosteks, + trouseaus, parathesias. Neuro- hyperreflexia, muscle cramping, weakness. Heart- increased HR, norm/low BP, increased dig tox. Resp- ^ rate/depth in resp, dec. resp effort in met.
pH: 7.50 Paco2: 29 mm Hg HCO3-: 24 mm Hg Respiratory Alkalosis. (pH High, CO2 low)
pH: 7.25 Paco2: 61 mm Hg HCO3-: 26 mm Hg Respiratory acidosis. (pH low, CO2 high)
pH: 7.15 Paco2: 30 mm Hg HCO3-: 10 mm Hg Metabolic acidosis with partial resp. compensation. (pH low, CO2 low, Bicarb low... pH and Bicarb follow the pattern, CO2 doesn't so it's compensation)
pH: 7.49 Paco2: 40 mm Hg HCO3-: 29 mm Hg Metabolic alkalosis (pH high, Bicarb high)
Created by: rwrigh17